Echinococcosis ultrasound

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor-In-Chief: Mahshid Mir, M.D. [2] ; Cafer Zorkun, M.D., Ph.D. [3]; Kalsang Dolma, M.B.B.S.[4]


The imaging technique of choice for cystic echinococcosis is ultrasonography since it is not only able to visualize the cysts in the body’s organs but it is also inexpensive, non-invasive and gives instant results.[1][2] Ultrasonography has been widely used for screening, clinical diagnosis, and monitoring of treatment of liver and intraabdominal cysts.

Echinococcosis ultrasound

  • On ultrasound, cyst appears as a hyperechoic mass with a heterogeneity and contains scattered calcifications with irregular, poorly defined edges.
  • May show a double echogenic shadow due to the pericyst. 
  • A central necroetic cavity with a hypoechoic pseudoliquid structure and anfractuous borders can also be demonstrated.
  • Multiseptate cyst with "daughter" cysts and echogenic material between cysts may be seen.
  • If the calcifications are associated with a positive result on specific serology, they may represent abortive forms of the disease.
Type of cyst Status Ultrasound features Remarks
CL Active
  • Unilocular,
  • No cyst wall
  • Usually early stage
  • Not fertile
CE1 Active
  • Cystic wall
  • Hydatid sand
  • Fertile cyst
CE2 Active
  • Multivesicular, cyst wall, rosette-like
  • Fertile cyst
CE3 Transistional
  • Detached laminated membrane
  • “Water lily” sign
  • Decreased intracystic pressure
  • Beginning of degeneration
  • May produce daughter cyst
CE4 Inactive
  • Heterogeneous hypoechogenic or hyperechogenic degenerative contents
  • No daughter cyst
  • No living protoscolices
CE5 Inactive
  • Thick, calcified wall, calcification partial to
  • Highly suggestive of diagnosis
  • No living protoscolices

Hepatic hydatid cyst

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  1. Macpherson, Calum N.L., Ruth Milner, and . "Performance Characteristics and Quality Control of Community Based Ultrasound Surveys for Cystic and Alveolar Echinococcosis." Acta Tropica 85. (2003): 203-09. Web. 24 February 2010.
  2. Brunetti, Enrico, Peter Kern , and Dominique Vuitton. "Expert Consensus for the Diagnosis and Treatment of Cystic and Alveolar Echinococcosis in Humans." Acta Tropica (2009). Web. 24 February 2010.

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